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Nursing

Understanding and management of behavioral disturbance in dementia

Abstract

In nursing homes, there are often significant challenges with respect to overcrowding and limited staffing. Patients diagnosed with dementia often pose considerable concerns for nursing staff because they require significant patient care, including bathing, dressing, feeding, and other requirements. In some cases, patients with dementia also possess severe behavioral challenges, yet they are placed into rooms with healthier patients with greater cognitive capabilities. This is a difficult circumstance due to the substantial behavioral differences between the patients and the potential for a diminished quality of life. Nurses must be effectively trained and prepared to provide the appropriate level of care and treatment to these patients and to address behavioral difficulties as quickly as possible to prevent additional problems and to reduce long-term consequences for patients and for the nursing unit.

Learning Objectives

The primary learning objectives under this example include the following: 1) To provide nurses with adequate training and guidance in working with dementia patients so that the quality of life of healthier patients is not compromised at any stage during their stay; 2) To obtain specific knowledge and information regarding the development of new concepts and tools to improve the dynamic between patients at different behavioral levels; and 3) To determine how to improve the quality of life for all patients in nursing homes, and in particular, those with significant cognitive differences who share living space. Each of these objectives will contribute to the expansion of nursing knowledge and practice in different ways and will accommodate the improvement of patient care and treatment for all patients in nursing home settings, including those with dementia and those with normal cognitive abilities, so that cohabitation is as smooth as possible.

Literature Review

Patients who are diagnosed with dementia at different stages are likely to pose considerable challenges to nurses working in long term care facilities because behavioral and cognitive deficits may create obstacles in providing effective patient care and treatment. It is important to recognize these issues as early as possible after new patients are admitted in order to develop a care plan which will provide optimal care and treatment for this group. In addition, patients without severe cognitive deficits or dementia must be effectively treated in conjunction with dementia patients. It is important for nurses working in these facilities to recognize the challenges of this care and how to balance the needs of dementia patients with patients with normal cognition.

Nurses working with dementia patients must be knowledgeable and skilled in all areas of nursing practice associated with this population group, and this is best accomplished with successful communication efforts for patients with dementia (Vasse et.al, 2010). An effective communication strategy requires nurses to understand the needs of dementia patients as best as possible, as there are significant issues associated with neuropsychiatric symptoms and other related concerns (Vasse et.al, 2010). In many cases, “the resident’s impaired communication skills make it very difficult for care staff to identify and address the source of the disturbed behavior” (Vasse et.al, 2010). Under these conditions, nurses are often ill prepared to effectively manage this patient population at a comprehensive level; therefore, dementia patients are not always cared for in the ideal manner (Vasse et.al, 2010). To complicate matters even further, due to space limitations, some dementia patients are placed into rooms with patients who have no challenging cognitive deficits, which makes it very difficult for these other patients to achieve an acceptable quality of life in many cases.

Nurses and other employees working with dementia patients must be provided with a comprehensive set of tools which will facilitate effective treatment and management of this patient population. Dementia education must be comprehensive and must consider a wide variety of scenarios and cognitive deficits which could impact this group of patients, including communication, the loss of memory, and the inability to perform basic daily functions. This training program should encompass different scenarios which nurses are likely to encounter in working with dementia patients, in addition to balancing the role of dementia caregiver with other responsibilities. Nurses who work with dementia patients must recognize that this group is unique and typically requires more assistance than other patients (Jootun and Pryde, 2013).

Nurses working with dementia patients should not only recognize the cognitive deficits of this condition, but also the physical limitations that these patients face. In many cases, patients require substantial physical assistance, including lifting and moving (Jootun and Pryde, 2013). These activities require expert knowledge to promote safety and wellbeing for both patients and nurses, and effective training is necessary to accomplish these objectives (Jootun and Pryde, 2013). Nursing education in these and other areas may assume many forms; however, proven methods should be considered above all others. Nurses must recognize dementia and how it impacts this population group in the form of physical and cognitive deficits in different forms. Nurses must be trained to perform routine assessments and to recognize changes in status and decline so that care plans are modified accordingly.

Nurse training for patients with dementia must primarily focus on preserving the quality of life as best as possible to accommodate physical and cognitive decline (Cordner et.al, 2010). Health Related Quality of Life (HRQOL) is of critical importance to nurses in providing optimal care and treatment to dementia patients; however, there are significant gaps in knowledge and training in this area (Cordner et.al, 2010). Nonetheless, it is necessary for nurses to recognize that dementia patients cannot care for themselves and do what is necessary to improve the quality of their lives; therefore, others must recognize these areas and do what is necessary to improve the quality of life as best as possible (Cordner et.al, 2010). However, some of these patients who face severe cognitive deficits and physical limitations are far beyond the preservation of the quality of their lives and at this stage, keeping them as comfortable as possible is all that can be done (Cordner et.al, 2010). It is the responsibility of nurses working with these patients to be prepared for these types of events and to recognize how to effectively care for patients with advanced dementia, particularly since they cannot communicate themselves (Cordner et.al, 2010). In addition, similar to the care provided at the end of life for terminally ill patients, dementia caregivers must be prepared to treat these patients using a variety of training tools, such as classroom instruction, hands-on training, and simulation (Ladd et.al, 2013) The latter represents an opportunity for nurses to experience simulated situations prior to caring for dementia patients to obtain a better perspective regarding this condition and its impact on quality of life (Ladd et.al, 2013).

Conclusion

The development of an effective training tool for nurses working with dementia patients in nursing homes is essential in understanding the condition, the levels of decline, and the level of care that is required at each stage. Nursing education is critical in this area because there are many difficult issues to consider when these patients lose their cognitive and physical capacity on a gradual basis. It is the responsibility of nurses to also develop strategies to care for dementia patients who are placed with other patients without cognitive deficits, as this dynamic is common and difficult to manage. Nurses must be effectively trained in these areas in order to establish successful care and treatment for these patients.

References

Cordner, Z., Blass, D.M., Rabins, P.V., and Black, B.S. (2010). Quality of life in nursing home residents with advanced dementia. Journal of the American Geriatric Society, 58(12),  2394-2400.

Jooden, D., and Pryde, A. (2013). Moving and handling of patients with dementia. Journal of  Nursing Education and Practice, 3(2), 126-131.

Ladd, C., Grimley, K., Hickman, C., and Touhy, T. (2013). Teaching end-of-life nursing using   simulation. Journal of Hospice & Palliative Nursing, 15(1), 41-51.

Vasse, E., Vernooij-Dassen, M., Spijker, A., Rikkert, M.O., and Koopmans, R. (2010). A systematic review of communication strategies for people with dementia in residential and nursing homes. International Psychogeriatrics, 22(2), 189-200.